Doctors know acne by the formal name of acne vulgaris. We know it simply as pimples, zits or spots. Upclose, acne can be seen as a mixture of different spots. There are inflamed spots (papules), some of which turn into yellow heads containing pus (pustules), blackheads and tiny little nodules or cysts.

Collectively termed blemishes, they mostly sprout from hair follicles - the reason men with hairy backs are more prone to acne. Besides the upper body, acne can also appear on the upper thighs and buttocks.

Who gets it?

When hormone levels rise, say in puberty, sebum production goes into overdrive. Teenagers are usually the ones to suffer due to their surging hormones. Girls and young women suffering from acne often find their condition worsening around the time of their period.

Others include pregnant women and patients on certain drug treatments. Adults with back acne tend to be sedentary or have sedentary jobs, for instance driving a taxi, or their work exposes them to heat and dust.

What causes it?

The problem lies in the oil-producing sebaceous glands, which are found all over the skin except on the palms and soles. However, sebum in itself does not cause acne. It is a combination of sebum, blocked pores and bacteria surrounding the skin.

These normally harmless bacteria proliferate when there is excessive sebum. Usually located next to the hair follicles, these skin bacteria eventually cause inflammation and with the melanin from the hair create a 'blackhead'. They also attract white blood cells that give rise to papules and subseguently pustules.

Why does back acne happen?

Controlling the sebaceous glands is the male hormone testosterone, so naturally males tend to produce more sebum than women. Contributory factors are heat and sweat. Acne tends to get worse in moist, tropical climates.

How is acne medically treated?

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Treatments vary according to the degree of severity. Mild lesions usually respond to benzoyl peroxide or salicylic acid creams or lotions. These act as antiseptics, killing bacteria and reducing sebum secretion. Antibiotic creams may be helpful, with more severe cases repuiring oral treatment.

In women these can be combined with the oral contraceptive pill to even out hormonal surges. The benefits take a while to be felt and at least four months' treatment is the rule. Still more severe cases reguire isotretinoin, which is expensive and may have serious side-effects as it is potentially dangerous to the unborn child if a woman is pregnant.

What aromatherapists say

Acned skin on the back and thighs can be improved dramatically with regular use of essential oils. The best oils are Tea Tree for its anti-bacterial properties and to help regulate sebaceous secretions. Lavender, too, is good as it helps healing and prevent scarring,

What doctors advise

Good nutrition, proper hygiene and plenty of water are, as always, very important. If you are prone to back acne, make sure you keep the area dry and clean - medicated washes help. Sunshine or UV light helps by drying the skin.

What not to do

Wear synthetic materials that trap heat.

Scrub too vigorously - it can lead to more inflammation and scars.

Use creamy body lotions - they block up the pores and make matters worse.

Wait too long before you see a dermatologist.

Good to try

A cooling water spray especially in hot weather.

Yoghurt to eat. Studies have shown that acidophilus can help in treating acne.

Vitamin A taken orally. It's known to have a controlling effect on the skin, thus reducing sebum production and zits.

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Most people with facial acne have some amount of body acne as well. Body acne develops in a similar way to facial acne. However, the skin on the body can be thicker than that on the face and often has larger pores, making for more severe acne lesions at times.Mike Walden Review